Community-acquired respiratory viruses

A multicenter study to define the epidemiology and outcomes of Clostridioides difficile infection in pediatric hematopoietic cell and solid organ transplant recipients.

Underimmunization of the solid organ transplant population: An urgent problem with potential digital health solutions.

Travel Medicine and Transplant Tourism in Solid Organ Transplantation

Mycobacterium tuberculosis in Solid Organ Transplant Recipients

Dilemma of organ donation in transplantation and the COVID-19 pandemic

The leading cause of death in solid organ and hematopoietic stem cell transplant recipients is infection. The respiratory viruses, particularly respiratory syncytial virus, influenza, parainfluenza, adenovirus, and picornaviruses, are increasingly recognized as significant pathogens in these populations. Respiratory syncytial virus has again been found to be the most common of the respiratory viruses causing severe infections in transplant recipients. Advances in prevention, particularly with regard to infection control practices, and to lesser extent treatment have had a substantial impact on the frequency and outcomes of this infection. New studies have clarified the impact of influenza in the hematopoietic stem cell transplant recipients and have provided evidence to support the use of M2 and neuraminidase inhibitors for early treatment. The epidemiology of parainfluenza and adenovirus in transplant recipients has been clarified, although therapeutic modalities are still limited and understudied. New antiviral medications may bring improved outcomes of picornavirus infections in this population. Finally, a new virus, the human metapneumovirus, has recently been described and may be a significant respiratory pathogen in immunocompromised transplant recipients. Studies published over the past year have documented a new respiratory pathogen. They have also resulted in improved understanding of the epidemiology of all of the respiratory virus pathogens, and have contributed to improve management of respiratory syncytial virus and influenza infection in hematopoietic stem cell transplant and solid organ transplant recipients.

Multisystem inflammatory syndrome in children associated with SARS-CoV-2 in a solid organ transplant recipient.

Optimal time to provide skin cancer and photoprotection education to pediatric solid organ transplant recipients

ALVR106, an Off-the-Shelf, Multivirus-Specific T-Cell Therapy, for the Treatment of Respiratory Viral Infections: Results from a Phase 1, First-in-Human, Dose-Ranging Trial

Clinical outcomes and serologic response in solid organ transplant recipients with COVID-19: A case series from the United States.

Background RSV is the most common lower respiratory tract infection (LRTI) among children. Serious adverse outcomes are more likely among immunocompromised patients, including progression to pneumonia, respiratory failure, and increased mortality rates. We present interim analyses results from a secondary data use multi-site study to characterize the morbidity and mortality associated with RSV infection among pediatric SOT patients. Method Pediatric (< 18 years old at transplant) SOT recipients from 10 U.S. transplant centers from the Pediatric Infectious Diseases Transplant Network (PIDTRAN) who underwent SOT between 2010 and 2019 and were RSV positive within 365 days of SOT were identified from medical records. Demographics, underlying condition, and clinical characteristics were abstracted and entered in an electronic REDCap survey. Descriptive statistics were used to characterize the clinical course and outcomes of RSV infection. Results In total, 40 SOT patients were eligible for analysis with 40 (93%) reporting 1 case of RSV within 365 days of transplant and 3 (7%) reported 2 episodes resulting in 43 RSV episodes. Over half (24, 60%) were male, 24 (60%) were white/Caucasian, with a median age of 2 years at the time of RSV diagnosis. The majority received 1 SOT (80%) prior to RSV diagnosis. The most common transplanted organ was liver 17 (42%) followed by heart 14 (36%) and kidney 9 (22%). Among the 43 episodes reported, almost half (46.5%) were diagnosed with LRTI at the time of RSV diagnosis and 29 (67.4%) required hospitalization. Among the 43 episodes, none received palivizumab and 1 (2.3%) received IVIG in the 4 weeks prior to RSV diagnosis. Nearly half (21, 48.8%) received oxygen support at least 4 hours per day (at least one day) with 3 (15%) requiring ventilator support. Only 2 (5%) were treated with ribavirin while 3 (7%) received IVIG within 28 days for the treatment of RSV. None received palivizumab within 28 days of diagnosis for RSV treatment. Among those who initially presented with upper respiratory tract infection, 2 (10%) progressed to LRTI after initial diagnosis of a URTI. One (2.4%) death related to RSV was reported. Conclusion Preliminary results from this continuing multi-site study demonstrate RSV is an ongoing concern among SOT recipients with approximately half developing LRTI and two thirds requiring hospitalization. These data help our understanding of RSV infections in this population and inform future prospective study designs to better define RSV risk as well as help address optimal prophylaxis and treatment strategies for SOT recipients at risk for severe illness.

Parasitic Infections in Solid Organ Transplantation

Fungal infections

Respiratory syncytial virus (RSV) is a major cause of serious acute lower respiratory tract infection in infants and the elderly. The lack of a licensed RSV vaccine calls for the development of vaccines with other targets and vaccination strategies. Here, we construct a recombinant protein, designated P-KFD1, comprising RSV phosphoprotein (P) and the E.-coli-K12-strain-derived flagellin variant KFD1. Intranasal immunization with P-KFD1 inhibits RSV replication in the upper and lower respiratory tract and protects mice against lung disease without vaccine-enhanced disease (VED). The P-specific CD4+ Tcells provoked by P-KFD1 intranasal (i.n.) immunization either reside in or migrate to the respiratory tract and mediate protection against RSV infection. Single-cell RNA sequencing (scRNA-seq) and carboxyfluorescein succinimidyl ester (CFSE)-labeled cell transfer further characterize the Th1 and Th17 responses induced by P-KFD1. Finally, we find that anti-viral protection depends on either interferon-γ (IFN-γ) or interleukin-17A (IL-17A). Collectively, P-KFD1 is a promising safe and effective mucosal vaccine candidate for the prevention of RSV infection.

Adenovirus in Solid Organ Transplant Recipients